Searching for ways to reduce medical errors and keep patients safe?
Look up.
That’s the idea of some patient-safety experts, who today will discuss the formation of an independent patient-safety agency modeled on the National Transportation Safety Board, and other strategies to reduce errors at a summit in Washington.
Many of the safety and error-prevention strategies used in aviation are applicable to health care, such as investigating the root causes of accidents and developing programs to reduce fatalities, experts say. One pilot who will share lessons from aviation’s best practices at the summit: retired US Airways pilot Chesley “Sully” Sullenberger, who coolly brought down stricken Flight 1549 into the Hudson River with no loss of life.
“Surfing the Healthcare Tsunami,” a new patient-safety documentary looking at solutions such as safety protocols for hospitals, will also premier at the summit. The Discovery Channel will show the film on April 28, with repeats over subsequent weeks. It will feature actor and patient-safety advocate Dennis Quaid, whose 12-day old twins received an overdose of heparin, a blood thinner, in a Los Angeles hospital that put them at serious risk, as the Health Blog discussed in 2008.
The concept of an NTSB for health care first surfaced in a report by the Institute of Medicine and has been taken up by patient-safety advocates led by Dr. Charles Denham. He’s chairman of the Texas Medical Institute of Technology, or TMIT, a nonprofit research group that supports development and dissemination of patient-safety practices.
Denham tells the Health Blog that the idea isn’t to create another layer of health-care bureaucracy, or a new federal agency, but a public/private partnership that could be run at minimal cost to taxpayers — perhaps 10 to 25 cents a year per citizen.
“Consumers are absolutely shocked that that there is no safety entity for hospitals and health care,” Denham says.
In an article in the Journal of Patient Safety, Denham, Sullenberger, Quaid and aviation-safety expert John Nance argue that, just as the NTSB issues “Blue Cover” reports that detail findings on aviation accidents, a patient-safety board would publicly disclose the causes of preventable harm and outline strategies for keeping such events from happening again.
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